Operative treatment of Schwannoma, the primary sacral tumor--case presentation

Sacral bone tumors constitute a separate group in spinal surgery among all other neoplastic dis-orders due to the specificity of clinical symptoms and methods of surgical treatment. In the majority of cases, in the initial phase, symptoms are nonspecific for neoplastic disease, which is a sig-nificant factor delaying the final diagnosis. At the moment of diagnosis, most tumors are so large in size that removing the whole mass carries a risk related to the extent of surgery and maintaining the stability of pelvic girdle and sacro-lumbar junction. In this publication we present a case of a 38-year-old female patient with primary sacral tumor (S2-S4) undergoing surgical treatment at the Spinal Surgery, Oncological Orthopedics and Traumatology Clinic at Poznan University of Medical Sciences. The patient was referred to an orthopedic outpatient clinic following gynecological surgery for removal of a suspected tumor of the uterus confirmed in an ultrasound examination. In a control magnetic resonance examination (MRI) there was a pathological mass visualized within the sacral bone infiltrating the presacral region and compressing the distal part of the colon. The patient underwent subtotal sacrectomy from a posterior approach. In order to reconstruct the posterior pelvic wall, biological material Permacol™ was used. There was a transient anal sphincter atony and urinary bladder paresis as well as sensory disturbances in S3-S5 dermatomes after the surgery. Several days after surgery, the patient was diagnosed with a deep cutaneous fistula and a significant volume of fluid in the postoperative cavity (in control CT). VAC treatment was implemented following a few days of passive drainage and significant improvement as well as secondary closing of the fistula were observed within a short period of time.